Case Makes His Case

Gary Baldwin, for HealthLeaders Media, March 4, 2008
During his keynote speech last week at HIMSS conference, Steven Case made one very pointed observation. When it comes to managing their own healthcare, the AOL founder said, "consumers have shirked their responsibilities. It is their responsibility to take more responsibility for their own health." That's a concept you don't hear much at healthcare conferences, particularly those with an IT focus like HIMSS. But Case has a good point. For many consumers, healthcare is something that is done to them, not something they participate in actively.

It's a model that Case would like to turn on its head with his new company, the ambitiously named Revolution Health. During his brief commentary (Case graciously left plenty of time for audience questions), he described the problems besetting the industry of rising cost and pernicious clinical problems, such as the obesity epidemic. In Case's view, consumerism is an inevitable force in healthcare, especially given the assumption that we patients will be asked to foot an increasingly bigger chunk of the cost in the days ahead. His new venture hopes to seize on this momentum, offering online content and connectivity services that are consumer-centric. Among the services is a personal health record, a technology space that is rapidly becoming crowded.

His thinking is that, if consumers take charge of their own health record, and that record is buttressed by various healthcare alerts, then they surely will become healthier, and sidestep many of the chronic lifestyle conditions that confront physicians and nurses every waking moment. In that sense, Case does have a "revolutionary" view of the medical record. Medical records should not be passive, but rather should stimulate activity on the part of the consumer, he said. "We want to build a health reminder system, as opposed to being in the file cabinet business."

In my mind, there's no doubt that unless consumers start accepting responsibility for managing their own health, we will continue to be hampered by burgeoning waistlines, rising cholesterol counts, and vexing health issues. I do question whether the mere presence of an electronic alert would be enough to prod people into healthier behavior. However, as electronic devices work their way into the homes, and as consumers start dispatching clinical data from those devices to their caregivers, I can easily imagine a type of "Hawthorne effect" setting in. If patients know they are being watched, they might very well change their behavior, and keep their weight at the right level.

Case has his share of critics, and he freely conceded that to many in the industry, he is a naïve outsider. There is some truth to that. He is wandering into a thicket of third-party payers, disconnected IT systems and convoluted organizational structures. But as Case recalled, he faced similar skepticism during the early days of AOL. Back then, the idea that the Internet would become a ubiquitous component of modern life was not held by many. Nobody dreamed our nation would become so rotund either.

P.S. Thanks to the scores of providers and vendors who e-mailed before (and during) HIMSS, inviting me to hear their presentations, see demonstrations at their booths, or simply meet in person. There were simply too many invitations to oblige everyone, but I had many productive encounters. On the HealthLeaders Media Technology pillar page, you will find links to a few of the stories I filed during HIMSS. Under "Top Stories" you will find links to other non-HIMSS stories (yes, they do exist!) that appeared last week. Next week, I will provide some additional wrap-up and commentary on the goliath HIMSS show.

Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at
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